The Maternal Mental Health Expert Most Moms Don't Know Exists — Dr. Claire Smith on Reproductive Psychiatry

Previa Alliance Podcast

In this episode of the Previa Alliance Podcast, host Sarah Parkhurst interviews Dr. Claire Smith, a reproductive psychiatrist, about the critical yet underrecognized

Key takeaways

• Reproductive psychiatry is a highly specialized field focused on mental health during reproductive life stages, including pregnancy, postpartum, perimenopause, and PMDD.
• Fewer than half of psychiatric residents receive meaningful training in perinatal mental health, leading to gaps in care for pregnant or postpartum patients.

Main topics

• Reproductive psychiatry
• Maternal mental health care gaps

Notable quotes

"Almost everybody that I, if anybody asks me what I do and they ask what kind of psychiatrist I am and I tell them almost nobody knows what it is."

Conclusion

Dr. Claire Smith emphasizes the urgent need for greater awareness, training, and

Transcript preview

Speaker 1 (0:09) Hi, guys. Welcome back to Preview Lions podcast. In light of the latest news, I'm sure everybody who hasn't lived under the rock has just been hearing about maternal mental health. If it wasn't from Hayden Panettiere's recent passing, who was one of the first ones to talk about postpartum depression, to the Clancy trial, which we all have become group chat warriors trying to figure out the verdict. I have brought back my favorite reproductive psychiatrist, Dr. Claire Smith. You guys know her. You love her. Welcome, Claire. And thank you again for your time. Yeah, of course. So, Claire. You're like a wild zebra out there. Okay. And more ways than one. I love you as a person, but what you do in your profession as reproductive psychiatry, people are like, okay, what is this? Why am I not hearing about this? And don't you think this is the time for the zebras to rise up and like really educate us all? Speaker 2 (1:08) Yeah. Zebra hive rise up. Speaker 1 (1:10) Yes, this is the time. Like in Madagascar, you know, the little zebra, that's like the one that's kind of left, you know, he's so funny, but it's like, come on, bud, you got it. I feel like it's this opportunity to really shine a light that there is true professionals, educated to utmost, out there who know truly how to help maternal mental health. But we're just not talking about it. Right, Speaker 2 (1:34) right. Speaker 1 (1:35) I can explain what reproductive psychiatry is if you want. I would love you to say first why you wanted reproductive psychiatry, what it is, and then give our listeners kind of a glimpse of like what kind of patients would come to you. Speaker 2 (1:48) Okay. Maybe you can prompt me if I forget any of those items. Speaker 1 (1:51) Yeah. Speaker 2 (1:53) So I was not planning to do psychiatry in medical school, really was not interested in psychiatry, didn't know much about it, didn't think that it was something I would want to do. And honestly, most of that is still accurate. But when I was at the very end of my third year of medical school, which is the year that you do all of your main core rotations in the hospital. I was almost finished and I was doing psychiatry. I was planning to do pathology, which is like way different. That's when you look under microscopes and do autopsies and things like that. And I did an elective, like a one week experience with an outpatient, like a clinical, I mean, a clinic psychiatrist. And she had a, an informal interest. They're not like had gone to a fellowship or anything in women's mental health, particularly for her, it was menopause and perimenopause. But then that introduced me a to outpatient psychiatry, which is very different from inpatient and be that there was a field that existed called reproductive psychiatry. And so I totally changed my path, um, went to psychiatry residency in order. only ever to do reproductive psychiatry. So I'm not interested in general. I'm not interested in inpatient. I'm not interested in seeing men. I'm not interested in any of that. So that is my path. And I went to residency for four years and then I did a fellowship in reproductive psychiatry for a year. And now I am a full-time reproductive psychiatrist. So what we do is it can vary from program to program or center to center. Some almost always, or basically always perinatal, meaning the period of pregnancy before, during, after is, um, is a part of reproductive psychiatry. And that is what I do essentially full-time. However, perimenopause and menopause can also be under reproductive psychiatry. PMDD and other premenstrual issues disorders can be under reproductive psychiatry. Some have more specific treatment for like infertility, you know, REI, oncology, all sorts of things can fit under the umbrella, but the biggest portion is perinatal. And so sometimes you hear the perinatal psychiatry being interchanged with reproductive psychiatry. Speaker 1 (4:35) How many people do you think go, wait, I didn't even know that was a thing to you. Speaker 2 (4:40) Almost everybody that I, if anybody asks me what I do and they ask what kind of psychiatrist I am and I tell them almost nobody knows what it is. Speaker 1 (4:50) And tell listeners who are going, okay, I didn't know. Why don't I know? Why don't people know? Speaker 2 (4:56) Well, even though 50 %-ish of the population are women, and the majority of those women will be pregnant or trying to get pregnant at some point, there has just been a real lack of probably interest and also fear around engaging in care. with that population because of the perceived risk in terms of fetal risk, you know, risk to baby. So for instance, if anybody's not aware, from 1977 to 1993, the FDA barred women from participating in any clinical drug research. So women in general, half the population, you're already operating way behind. Speaker 2 (5:52) in terms of drug research and clinical trials, randomized control trials and so on. So it was only the NIH in the early 90s who said, no, we have to look at women because some things are similar, some things are different, but we need this information because of, again, half the population is women and the majority of those people will get pregnant. And so it's only been in the last probably few decades, like maybe 20 years, that this has been a true academic field and the interest in terms of medical students and residents, psychiatry residents wanting to go into it, I'd say last. five to 10 years, it's growing quite a bit. But that's probably why. And also just lack of there, there aren't around as much. And so you don't come into contact with them as much. Speaker 1 (6:41) Many states do not have a U, which a lot of people may, they're going, okay. I think it's an important part, especially of listeners to hear this part is it's so blurry and we're seeing it in the trial. We're seeing it just when you're maybe looking for any kind of care is sometimes people put blanket statements of what they cover, right? Maternal mental health is like the hot buzzword now, right? To say, Speaker 2 (7:09) and Speaker 1 (7:09) there's different levels of training. There's different levels of exposure. Kind of just kind of talk about what if you, if they can't get to a you, a reproductive psychiatrist that specifically says they're fellowship trained or, you know, has that title. And maybe they're assuming a psychiatrist would do or a psychiatrist should have had this experience, right? Like how do they walk through those muddy waters as a patient? Speaker 2 (7:37) Yeah, it's difficult. The exposure to general psychiatry residents varies drastically. Some have literally zero. Some have the opportunity for a lot of exposure like my program does. or MUSC's program does, I should say. And some are somewhere in between. Some get lectures, but no clinical experience. Some get lectures and clinical experience. So it can be really hard. But I do think that most psychiatrists or mental health providers, like maybe your option is a nurse practitioner or a PA, you know, those are the realistic options for a lot of people, particularly if you have Medicaid, is just asking what their comfort level is. in perinatal psychiatry and treating pregnancy and knowing what to do if a pregnancy occurs because half of them are unplanned. And there are a lot of psychiatrists. As much as I appreciate and love all my colleagues, they're my biggest problem because they will start medications and just sort of... They have no idea what to do if and when someone gets pregnant, and then they freeze and say, stop all your medication. Or I don't know what to do. You'll have to find somebody else. And that's not always an easy thing to do. And so patients can get the runaround, get the wrong advice, which is usually fear-based advice, but lack of that exposure and training like you're talking about. So just asking, they should be able to say pretty truthfully whether they are or are not comfortable. Speaker 1 (9:08) And I think it could be very honest of saying, hey, how many severe postpartum depression patients have you treated? Are you comfortable with a history of bipolar and me being pregnant? Are you capable? Have you ever treated a postpartum psychosis woman? Have you ever been exposed to that during residency? And it's uncomfortable to ask these things because you, A, you don't want to like. assume you're going to have that. But if you know your risk factors, I think it's those, it's that we're at the point of lack of true maternal mental health care for moms that you have to go in almost assuming you're at a negative and you have to figure out what works for you. Like you're not a surplus. It's not like pediatricians where a lot of times you can throw a rock and hit one in most towns. Speaker 2 (10:02) Right. That's Speaker 1 (10:02) what Speaker 2 (10:02) I was thinking while you were talking is it probably feels uncomfortable to ask those questions because, A, as a society, we really aren't ingrained to question doctors. And you feel like you're interrogating them or you're being difficult or those types of things, particularly women. Of course, we struggle with that. But also, like if, say, this person says no, maybe that's what you thought your only option was. Like you said, you're not just. hanging on the trees everywhere. So sometimes it can feel like you have to accept whatever it is in front of